Format Bpjs Kabupaten 2015 2

FORMAT

6

7

8

9

/T1..n 1

2

3

4

5

3=J, 4=D 10

11 12

13

Kode Faskes Dokter Gigi

L=1 'P=2

Nama Faskes Tk.I

dd/mm/yyyy

Kode Faskes Tk.I

Tempat Lahir

Alamat Tempat Kode RTRW Tinggal Pos

Nama Desa

KITAP

P/I/S /A1..3

1=K, 2=B,

Kode Desa

Nama Lengkap

Nama Kecamatan

No KK

Tgl Lahir

Kode Kecamatan

No

PISAT

Status Kawin

NIK/KITAS

Jenis Kelamin

DAFTAR PENERIMA BANTUAN IURAN JAMINAN KESEHATAN MELALUI ANGGARAN PENDAPATAN DAN BELANJA DAERAH KABUPATEN TOBA SAMOSIR

14

15 16

17

18

19

20

1

24210390120005 121201020552000 Mangasa Napitupulu 5

P

Balige

05-02-1952

1

1

Balerong

0 0

22313 121201 Balige

Napitupulu

0206030101 Puskesmas 0 Balige

2

1212012004100314121201100650002 Basmen Simanjuntak

P

Parsuratan

08-10-1965

1

1

Jl. Mulia Raja Ujung

0 0

22313 121201 Balige

Napitupulu

0206030101 Puskesmas 0 Balige

3

12120105111200011212014203110001Navda N. Napitupulu

A

Balige

03-02-2011

2

2

Napitupulu D. Tolong 0 0

22313 121201 Balige

Napitupulu

0206030101 Puskesmas 0 Balige

4

12120108020800451212010812650001Darwin Napitipulu

P

Balige

08-12-1965

1

1

Bukit Barisan

0 0

22313 121201 Balige

Napitupulu

0206030101 Puskesmas 0 Balige

5

12120112060900021212015708560001Risma Uli Hutajulu

I

Laguboti

17-08-1956

2

1

Napitupulu

0 0

22313 121201 Balige

Napitupulu

0206030101 Puskesmas 0 Balige

6

041103901206

I

Medan

06-03-1951

2

1

Bukit Barisan

0 0

22313 121201 Balige

Napitupulu

0206030101 Puskesmas 0 Balige

7

12120108121100091212015305840004Meiland Napitupulu

I

Balige

13-05-1984

2

1

Bukit Barisan

0 0

22313 121201 Balige

Napitupulu

0206030101 Puskesmas 0 Balige

8

12120129041000051212011706470004Walon M. Aruan

P

Jakarta

17-08-1947

1

1

Napitupulu Bagasan

0 0

22313 121201 Balige

Napitupulu

0206030101 Puskesmas 0 Balige

1212014603510002Sondang L.Tobing

9

12120129041000051212015701560003Helperia S. Napitupulu

I

Balige

17-01-1956

2

1

Napitupulu Bagasan

0 0

22313 121201 Balige

Napitupulu

0206030101 Puskesmas 0 Balige

10

12120129041000051212016502480001Tiurmara Sitompul

I

Balige

25-02-1946

2

1

Napitupulu Bagasan

0 0

22313 121201 Balige

Napitupulu

0206030101 Puskesmas 0 Balige

11

12120120071100101212015104840003Sudarsi

I

Kisaran

11-04-1984

2

1

Napitupulu D. Tolong 0 0

22313 121201 Balige

Napitupulu

0206030101 Puskesmas 0 Balige

12

12120115063700151212015608690003Mariani Nainggolan

I

P.Siantar

16-08-1969

2

1

Mulia Raja Ujung

0 0

22313 121201 Balige

Napitupulu

0206030101 Puskesmas 0 Balige

13

12120115060700141212012711620001Resman Mangandar

P

Balige

27-11-1962

1

1

Jln. Mesjid

0 0

22313 121201 Balige

Napitupulu

0206030101 Puskesmas 0 Balige

1

1

Jl.Napitupulu bagasan 0 0

22313 121201 Balige

Napitupulu

0206030101 Puskesmas 0 Balige

14

Rinto Riyani Simanjuntak Juliver Napitupulu

17

12120127080900081212015512510001Rita Napitupulu

P

Balige

15-12-1951

2

3

Jln. Lbn Simangambit 0 0

22313 121201 Balige

Napitupulu

0206030101 Puskesmas 0 Balige

18

12120101020507271212011406710000Josafat Purba

P

Barus

14-06-1971

1

1

Balige I

0 0

22313 121201 Balige

Balige I

0206030101 Puskesmas 0 Balige

19

12120102050727 1212015411700001Tiur Sinaga

I

Barus

09-10-1970

2

1

Balige I

0 0

22313 121201 Balige

Balige I

0206030101 Puskesmas 0 Balige

20

121201070910007 1212016710960002Putri Dewi M. Sinaga

A

Balige

27-10-1996

2

2

Balige I

0 0

22313 121201 Balige

Balige I

0206030101 Puskesmas 0 Balige

21

121201070910007 1212012004990005Andri Panahatan Purba

A

Balige

20-04-1999

1

2

Balige I

0 0

22313 121201 Balige

Balige I

0206030101 Puskesmas 0 Balige

22

12120101020507271212015905010009Vera Dita Purba

A

Balige

19-05-2001

2

2

Balige I

0 0

22313 121201 Balige

Balige I

0206030101 Puskesmas 0 Balige

23

12120101020507271212010202040004Fernidan Purba

A

Balige

02-02-2004

1

2

Balige I

0 0

22313 121201 Balige

Balige I

0206030101 Puskesmas 0 Balige

24

12120109111100051212014507530002Donny Logoan Siahaan

I

Balige

05-07-1953

1

1

Balige I

0 0

22313 121201 Balige

Balige I

0206030101 Puskesmas 0 Balige

25

12120106011100131212010112550001Robert Siahaan

P

Balige

01-12-1955

1

1

Balige I

0 0

22313 121201 Balige

Balige I

0206030101 Puskesmas 0 Balige

26

12120109111100051212016205830004Maria Silalahi

I

Balige

22-'05-1983

2

1

Balige I

0 0

22313 121201 Balige

Balige I

0206030101 Puskesmas 0 Balige

27

12120109111100051212012003840005Mikael Silalahi

P

Balige

20-03-1984

1

1

Balige I

0 0

22313 121201 Balige

Balige I

0206030101 Puskesmas 0 Balige

28

12120109111100051212011707860006Anos Silalahi

A

Balige

17-07-1986

1

2

Balige I

0 0

22313 121201 Balige

Balige I

0206030101 Puskesmas 0 Balige

29

12120109111100051212011103910002Anggiat Silalahi

A

Balige

11-03-1991

1

2

Balige I

0 0

22312 121201 Balige

Balige I

0206030101 Puskesmas 0 Balige

30

121201240609001312120612680001

P

Balige

12-06-1968

1

1

Balige I

0 0

22312 121201 Balige

Balige I

0206030101 Puskesmas 0 Balige

Balige I

0 0

22312 121201 Balige

Balige I

0206030101 Puskesmas 0 Balige

31

Harry Hutagaol Manosor Elikson Simangunsong

32

12120122091000131212014611560002Rusmi Manurung

I

Laguboti

06-11-1956

2

1

Balige I

0 0

22312 121201 Balige

Balige I

0206030101 Puskesmas 0 Balige

33

12120119021400011212010404790002Charles Siahaan

A

Balige

04-04-1979

1

2

Balige I

0 0

22312 121201 Balige

Balige I

0206030101 Puskesmas 0 Balige

34

12120116081100041212012707900004Riduan Sirait

A

Baruara

27-07-1990

1

2

Baruara

0 0

22312 121201 Balige

Baruara

0206030101 Puskesmas 0 Balige

35

1212011510120039121201560844001 Farida Batubara

I

Sitonggi tonggi

16-08-1944

2

1

Baruara

0 0

22312 121201 Balige

Baruara

0206030101 Puskesmas 0 Balige

36

12120111121100071212010710070001Andi P Butar-Butar

A

Tambunan

10-07-2007

1

2

Lumban Gaol

0 0

22313 121201 Balige

Lumban Gaol

0206030101 Puskesmas 0 Balige

37

12120112020800961212012906020001Gabe B Tambunan

A

Tambunan

29-06-2002

1

2

Lumban Gaol

0 0

22313 121201 Balige

Lumban Gaol

0206030101 Puskesmas 0 Balige

38

KK dlm Pengurusana1212015812440001Rosmani Silitonga

P

Sipahutar

18-12-1944

2

3

Lumban Gaol

0 0

22313 121201 Balige

Lumban Gaol

0206030101 Puskesmas 0 Balige

39

1212013108120004121201170297003 Jaka Chandra

P

Jakarta

17-02-1987

1

1

Lumban Gaol

0 0

22313 121201 Balige

Lumban Gaol

0206030101 Puskesmas 0 Balige

40

121201120208037612120149010001

A

Jakarta

09-07-2001

2

2

Lumban Gaol

0 0

22313 121201 Balige

Lumban Gaol

0206030101 Puskesmas 0 Balige

Mega Teremia

41

12120112020803761212015703680001Berliana Hutasoit

42

Yusuf Tambunan

I

Lbn. Gaol

11-05-1955

2

1

Lumban Gaol

0 0

22313 121201 Balige

Lumban Gaol

0206030101 Puskesmas 0 Balige

Lumban Gaol

0 0

22313 121201 Balige

Lumban Gaol

0206030101 Puskesmas 0 Balige

43

12120111111100011212012908810003Monang Tambunan

P

Tambunan

29-08-1981

1

4

Lumban Gaol

0 0

22313 121201 Balige

Lumban Gaol

0206030101 Puskesmas 0 Balige

44

1212011202080060

P

Tambunan

18-04-1987

1

2

Lumban Gaol

0 0

22313 121201 Balige

Lumban Gaol

0206030101 Puskesmas 0 Balige

45

12120115100800031212011905560001Elisman Hutagaol

P

Hutagaol

19-05-1956

1

1

Bonan dolok I

0 0

22313 121201 Balige

Bonan Dolok I

0206030101 Puskesmas 0 Balige

46

12120115100800031212016506580001Lamria Siagian

I

Bonandolok

25-06-1959

2

1

Bonan dolok I

0 0

22313 121201 Balige

Bonan Dolok I

0206030101 Puskesmas 0 Balige

47

12120104081000011212012505550004Kapman Siagian

P

Bonan Dolok I

25-05-1955

1

1

Bonan dolok I

0 0

22313 121201 Balige

Bonan Dolok I

0206030101 Puskesmas 0 Balige

48

12120124021100381212012303500001Wilter Siagian

P

Bonan Dolok I

23-03-1950

1

1

Bonan dolok I

0 0

22313 121201 Balige

Bonan Dolok I

0206030101 Puskesmas 0 Balige

49

12120124021100381212014112540004Langgatan Simanjuntak

I

L. Gala-gala

01-12-1954

2

1

Bonan dolok I

0 0

22313 121201 Balige

Bonan Dolok I

0206030101 Puskesmas 0 Balige

50

12120107020801071212012307710002Donal Siagian

P

Bonan Dolok

23-07-1971

1

1

Bonan dolok I

0 0

22313 121201 Balige

Bonan Dolok I

0206030101 Puskesmas 0 Balige

51

12120107020801071212016606750002Lidia Tambunan

I

Tanah Gambus 26-06-1975

2

1

Bonan dolok I

0 0

22313 121201 Balige

Bonan Dolok I

0206030101 Puskesmas 0 Balige

Bonan dolok I

0 0

22313 121201 Balige

Bonan Dolok I

0206030101 Puskesmas 0 Balige

52

Burhan Tambunan

Manogari Siagian

53

12120106117700021212010611770002Porman Siagian

P

Simaranjan

06-11-1977

1

1

Bonan Dolok II

0 0

22313 121201 Balige

Bonan Dolok II

0206030101 Puskesmas 0 Balige

54

12120165037300021212016503730002Rendi Tampubolon

P

Lbn. Atas

25-03-1973

1

1

Bonan dolok II

0 0

22313 121201 Balige

Bonan Dolok II

0206030101 Puskesmas 0 Balige

55

12120118034300021212011803430001Saudin Batubara

P

Bonandolok

18-03-1943

1

1

Bonan dolok II

0 0

22313 121201 Balige

Bonan Dolok II

0206030101 Puskesmas 0 Balige

56

12120149045300011212016006530001Tiomsi Simorangkir

P

Tarutung

20-06-1953

1

1

Bonan dolok II

0 0

22313 121201 Balige

Bonan Dolok II

0206030101 Puskesmas 0 Balige

57

12120112110800021212011211080002Ruben Siagian

A

Bonandolok

12-11-2008

1

2

Bonan dolok II

0 0

22313 121201 Balige

Bonan Dolok II

0206030101 Puskesmas 0 Balige

58

12120112110800021212011120112000Ferdinan Siagian

A

Bonandolok

12-01-2012

1

2

Bonan dolok II

0 0

22313 121201 Balige

Bonan Dolok II

0206030101 Puskesmas 0 Balige

59

12120115105400151212015302920053Nurliana Siagian

A

Sihobuk

13-02-1992

2

2

Bonan dolok III

0 0

22313 121201 Balige

Bonan dolok III

0206030101 Puskesmas 0 Balige

60

1212011510540015121201150540015 Harlen Siagian

P

Sihobuk

15-10-1954

1

1

Bonan dolok III

0 0

22313 121201 Balige

Bonan dolok III

0206030101 Puskesmas 0 Balige

61

12120115105400151212015510530055Rosida Napitupulu

I

Bah. gunung

15-01-1953

2

1

Bonan dolok III

0 0

22313 121201 Balige

Bonan dolok III

0206030101 Puskesmas 0 Balige

62

121204510540015 1212012008954002Robin Siagian

A

Sihobuk

20-08-1998

2

2

Bonan dolok III

0 0

22313 121201 Balige

Bonan dolok III

0206030101 Puskesmas 0 Balige

63

12120115105400151212012712970027Jonatan Siagian

A

Sihobuk

27-12-1997

2

2

Bonan dolok III

0 0

22313 121201 Balige

Bonan dolok III

0206030101 Puskesmas 0 Balige

64

12120114021100131212010805700001Bisker Simanjuntak

P

Lbn. Gala-gala

08-05-1970

1

1

Bonan dolok III

0 0

22313 121201 Balige

Bonan dolok III

0206030101 Puskesmas 0 Balige

65

12120114021100131212015203760002Rosmida Sihotang

I

Lbk. Pakam

12-03-1976

2

1

Bonan dolok III

0 0

22313 121201 Balige

Bonan dolok III

0206030101 Puskesmas 0 Balige

66

121201022050325 121201022050325 Manahan Simanjuntak

P

Hutadame

03-04-1940

1

1

Huta dame

0 0

22313 121201 Balige

Huta dame

0206030101 Puskesmas 0 Balige

67

121201301100003 1212010502286000Binsar Simanjuntak

P

Huta dame

05-02-1986

1

1

Huta dame

0 0

22313 121201 Balige

Huta dame

0206030101 Puskesmas 0 Balige

68

12120130113000031212015005940002Apriani Ambarita

I

P. Siantar

10-05-1994

2

1

Huta Dame

0 0

22313 121201 Balige

Huta Dame

0206030101 Puskesmas 0 Balige

Huta dame

0 0

22313 121201 Balige

Huta dame

0206030101 Puskesmas 0 Balige

Huta dame

0 0

22313 121201 Balige

Huta dame

0206030101 Puskesmas 0 Balige

1

Huta Namora

0 0

22313 121201 Balige

Huta Namora

0206030101 Puskesmas 0 Balige

2

1

Huta Namora

0 0

22313 121201 Balige

Huta Namora

0206030101 Puskesmas 0 Balige

04-03-1990

2

1

Huta Namora

0 0

22313 121201 Balige

Huta Namora

0206030101 Puskesmas 0 Balige

Hutagalung

26-03-1947

1

1

Huta Namora

0 0

22313 121201 Balige

Huta Namora

0206030101 Puskesmas 0 Balige

I

Lbn. Julu

25-10-1946

2

1

Lbn. Julu

0 0

22313 121201 Balige

Huta Namora

0206030101 Puskesmas 0 Balige

12120195885400051212015602570056Renta Hutagaol

I

Hutagaol

16-02-1957

2

1

Hutagaol

0 0

22313 121201 Balige

Hutagaol

0206030101 Puskesmas 0 Balige

77

12120101074700041212014603510002Bilman Hutagaol

P

Hutagaol

01-07-1947

1

1

Hutagaol

0 0

22313 121201 Balige

Hutagaol

0206030101 Puskesmas 0 Balige

78

12120101074700041212010909490002Elferia Tambunan

A

Tambunan

09-09-1949

1

2

Hutagaol

0 0

22313 121201 Balige

Hutagaol

0206030101 Puskesmas 0 Balige

79

12120125115800251212016309590063Loiner Simanjuntak

I

Sihatandohan

23-09-1959

2

1

Hutagaol

0 0

22313 121201 Balige

Hutagaol

0206030101 Puskesmas 0 Balige

80

1212012202080161121201102530001 Patar Hutagaol

P

Simarmar

11-02-1953

1

1

Hutagaol Simarmar

0 0

22313 121201 Balige

Hutagaol

0206030101 Puskesmas 0 Balige

81

12120122020801611212016006540001Siti Hutahaean

I

Hutahean

20-06-1954

2

1

Hutagaol Simarmar

0 0

22313 121201 Balige

Hutagaol

0206030101 Puskesmas 0 Balige

82

12120130081200021212011002290004Daniel Hutagaol

P

Simarmar

11-02-1953

1

1

Hutagaol Simarmar

0 0

22313 121201 Balige

Hutagaol

0206030101 Puskesmas 0 Balige

83

12120114091000011212016407770002Erika Mesraida Tampubolon

I

Sibolahotang

24-07-1977

2

1

Sosor Dolok

0 0

22313 121201 Balige

Hutagaol

0206030101 Puskesmas 0 Balige

84

12120149103800011212015512710001Bertua Hutagaol

P

Sosor Dolok

15-12-1971

1

1

Sosor Dolok

0 0

22313 121201 Balige

Hutagaol

0206030101 Puskesmas 0 Balige

69

12120126101000051212015612470003Landus Hutahaean

I

Hutahaean

16-12-1947

2

70

12120103120700541212016111710001Ronti Tambunan

I

Huta dame

21-11-1971

2

71

12120107061000111212010612400001Janneas Sinaga

P

Tarutung

26-12-1940

1

72

12120107061000111212016806590001Ramlia Simangunsong

I

Nasonak

26-06-1956

73

12120106020800851212014403900005Nurlela Sitompul

I

Hutanamora

74

12120107020803411212012603470001Harlen Simangunsong

P

75

1212012605090001121201651046031 Mathile Simangunsong

76

1

85

12120126091200021212016502560065Sanur Simatupang

I

Sosor Dolok

25-02-1956

2

1

Sosor Dolok

0 0

22313 121201 Balige

Hutagaol

0206030101 Puskesmas 0 Balige

86

12120165025600651212011207930012Hendra Hutagaol

A

Sosor Dolok

12-07-1993

1

2

Sosor Dolok

0 0

22313 121201 Balige

Hutagaol

0206030101 Puskesmas 0 Balige

87

12120115037500041212011503750004Rudi Hutagaol

P

Medan

15-03-1975

1

1

Sosor Dolok

0 0

22313 121201 Balige

Hutagaol

0206030101 Puskesmas 0 Balige

88

12120115037500041212014109770008Erisda Marbun

P

Sosor Dolok

01-09-1977

1

1

Sosor Dolok

0 0

22313 121201 Balige

Hutagaol

0206030101 Puskesmas 0 Balige

89

12120115037500041212012201011000Roy Dandi Hutagaol

A

Jakarta

22-01-2001

1

2

Sosor Dolok

0 0

22313 121201 Balige

Hutagaol

0206030101 Puskesmas 0 Balige

90

12120114110008 1212014507750002Elida Marisi Hutagaol

I

Sosor Dolok

05-07-1957

2

1

Sosor Dolok

0 0

22313 121201 Balige

Hutagaol

0206030101 Puskesmas 0 Balige

91

12120128101400021212016704700002Nursalam Hutagaol

A

Sosor Dolok

27-04-1970

2

2

Sosor Dolok

0 0

22313 121201 Balige

Hutagaol

0206030101 Puskesmas 0 Balige

92

12120121100900041212011510680001Renson H. Nababan

P

Balige

15-10-1968

1

1

Jln. Gereja

0 0

22313 121201 Balige

Balige III

0206030101 Puskesmas 0 Balige

93

12120121100900041212016307650003Gokmauli Siahaan

I

P. Siantar

23-07-1965

2

1

Jln. Gereja

0 0

22313 121201 Balige

Balige III

0206030101 Puskesmas 0 Balige

94

12120117111100041212010204850003Miduk Simanjuntak

P

HT. Ginjang

02-04-1985

1

1

Jln. Jambu

0 0

22313 121201 Balige

Balige III

0206030101 Puskesmas 0 Balige

95

12120117111100041212014910740003Lenny Siregar

I

Balige

09-10-1974

2

1

Jln. Jambu

0 0

22313 121201 Balige

Balige III

0206030101 Puskesmas 0 Balige

96

12120125071100081212011204680002Toni H.Marpaung

P

Balige

06-04-1968

1

1

Jln. S. Debata

0 0

22313 121201 Balige

Balige III

0206030101 Puskesmas 0 Balige

97

12120225071100081212015803040004Devina Marpaung

A

Balige

18-08-2004

2

2

Jln. S. Debata

0 0

22313 121201 Balige

Balige III

0206030101 Puskesmas 0 Balige

98

12120125071100081212016304010004Winny Marpaung

A

Balige

23-04-2001

2

2

Jln. S. Debata

0 0

22313 121201 Balige

Balige III

0206030101 Puskesmas 0 Balige

I

Pakkat

15-10-1970

2

1

Jln.S.Debata

0 0

22313 121201 Balige

Balige III

0206030101 Puskesmas 0 Balige

100 12120117111100041212012707020002Samuel Mangaratua

A

Balige

27-03-2003

1

2

Jln. Jambu

0 0

22313 121201 Balige

Balige III

0206030101 Puskesmas 0 Balige

101 12120105011000061212010106680001Ronald Saragih

P

Balige

01-06-1968

1

1

Lbn. Saragi

0 0

22313 121201 Balige

Balige III

0206030101 Puskesmas 0 Balige

102 12120105011000061212016212700004Roni Manullang

I

Balige

12-12-1970

2

1

Lbn. Saragi

0 0

22313 121201 Balige

Balige III

0206030101 Puskesmas 0 Balige

103 12120105011000061212012105960001Togam Saragi

A

Balige

21-05-1996

1

2

Lbn. Saragih

0 0

22313 121201 Balige

Balige III

0206030101 Puskesmas 0 Balige

104 12120126081100011212010411750001Horas Tambunan

P

Balige

04-11-1975

1

1

Jl. Jambu

0 0

22313 121201 Balige

Balige III

0206030101 Puskesmas 0 Balige

105 12120126081100011212015606750001Christiana Sitompul

I

P. Sidempuan

16-06-1975

2

1

Jl. Jambu

0 0

22313 121201 Balige

Balige III

0206030101 Puskesmas 0 Balige

106 12120163073600631212016307360063Timoria Tambunan

I

Tambunan

23-07-1936

2

1

Lbn. Pea

0 0

22313 121201 Balige

Lbn. Pea

0206030101 Puskesmas 0 Balige

107 1271092712060003121201060750010 Kasianus Tambunan

P

Tambunan

08-07-1950

1

1

Lbn. Pea

0 0

22313 121201 Balige

Lbn. Pea

0206030101 Puskesmas 0 Balige

108 12120104081000101212014901750001Mastiur Aritonang

I

Balige

09-05-1975

2

1

Lbn. Pea

0 0

22313 121201 Balige

Lbn. Pea

0206030101 Puskesmas 0 Balige

109 12120120100800021212015611670003Sonti Manullang

I

Pakkat

16-11-1967

2

1

Lbn. Pea

0 0

22313 121201 Balige

Lbn. Pea

0206030101 Puskesmas 0 Balige

110 12120117130003 1212011562800002Indra N. Tambunan

P

Tambunan

15-02-1980

1

1

Lbn. Pea

0 0

22313 121201 Balige

Lbn. Pea

0206030101 Puskesmas 0 Balige

111 12120122120900021212016011560001Magdalena Sitohang

I

Lampinan

10-11-1956

2

1

Lbn. Pea

0 0

22313 121201 Balige

Lbn. Pea

0206030101 Puskesmas 0 Balige

112 212011211120003 1212015703760003Rugun Panjaitan

I

Tambunan

17-03-1976

2

2

Lbn. Pea

0 0

22313 121201 Balige

Lbn. Pea

0206030101 Puskesmas 0 Balige

113 12120125051000011212016705570005Magdalena Hutagaol

I

Medan

27-05-1957

2

1

Lbn. Pea

0 0

22313 121201 Balige

Lbn. Pea

0206030101 Puskesmas 0 Balige

99

12120125071100081212011520772000Tiurna Manullang

114

Sondang Nababan

0 0

22313 121201 Balige

Lbn. Pea

0206030101 Puskesmas 0 Balige

115 12120124051000101212016506610062Sorta Tambunan

I

Medan

25-06-1961

2

1

Lbn. Pea Timur

0 0

22313 121201 Balige

Lbn. Pea Timur

0206030101 Puskesmas 0 Balige

116 12120114025700141212010804990008Oloan Tambunan

A

Tambunan

08-04-1999

1

2

Lbn. Pea Timur

0 0

22313 121201 Balige

Lbn. Pea Timur

0206030101 Puskesmas 0 Balige

117 12120114025700141212017112640001Rosmani Manurung

I

Lbn. Julu

31-12-1964

2

1

Lbn. Pea Timur

0 0

22313 121201 Balige

Lbn. Pea Timur

0206030101 Puskesmas 0 Balige

118 12120108051000061212014608020002Lisdayanti Emelia Manullang

A

Tambunan

2

2

Lbn. Pea Timur

0 0

22313 121201 Balige

Lbn. Pea Timur

0206030101 Puskesmas 0 Balige

119 12120110100800031212016510560001Rumintang Sitorus

P

Tiga dolok

25-10-1958

2

3

Lbn. Pea Timur

0 0

22313 121201 Balige

Lbn. Pea Timur

0206030101 Puskesmas 0 Balige

120 12120119020900051212012003440001Hisar Tambunan

P

Tambunan

20-03-1944

1

1

Lbn. Pea Timur

0 0

22313 121201 Balige

Lbn. Pea Timur

0206030101 Puskesmas 0 Balige

121 12121126020800451212010805630003Bakti Tampubolon

P

Janjimaria

01-05-1963

1

1

Saribu Raja

0 0

22313 121201 Balige

Janjimaria

0206030101 Puskesmas 0 Balige

122 12120107091000081212016801680002Lisbet R Tampubolon

I

Balige

28-01-1968

2

1

Saribu Raja

0 0

22313 121201 Balige

Janjimaria

0206030101 Puskesmas 0 Balige

123 121201602080004 1212015111540051Resianna Tampubolon

I

Balige

14-04-1981

2

1

Sariburaja

0 0

22313 121201 Balige

Janjimaria

0206030101 Puskesmas 0 Balige

124 12120113071000011212014701850006Justan Simanjuntak

S

Balige

18-08-1945

1

1

Saribu Raja

0 0

22313 121201 Balige

Janjimaria

0206030101 Puskesmas 0 Balige

125 12120119020801311212016001640080Ria Sihombing

I

L. Nihuta

20-01-1964

2

1

Saribu Raja

0 0

22313 121201 Balige

Janjimaria

0206030101 Puskesmas 0 Balige

126 12120108121100061212016611830004Lisnawaty Tambunan

I

Balige

26-11-1983

2

1

Saribu Raja

0 0

22313 121201 Balige

Janjimaria

0206030101 Puskesmas 0 Balige

127 12120122050900011212012412550001Dumangar Tampubolon

P

Lbn. Atas

24-12-1955

1

1

Saribu Raja

0 0

22313 121201 Balige

Janjimaria

0206030101 Puskesmas 0 Balige

128 12120108121100061212014209110001Diansyah Fitri

A

Balige

21-06-2006

2

2

Saribu Raja

0 0

22313 121201 Balige

Janjimaria

0206030101 Puskesmas 0 Balige

06-08-2002

129 12120119020800871212011206380001Eleteria Tampubolon

P

Balige

12-06-1938

2

3

Saribu Raja

0 0

22313 121201 Balige

Janjimaria

0206030101 Puskesmas 0 Balige

130 12120114111100031212011509800000Linggom Pardede

P

Balige

15-09-1980

1

1

P. Onan

0 0

22313 121201 Balige

P. Onan

0206030101 Puskesmas 0 Balige

131 12120122031000031212010612970004Rio Siahaan

A

Balige

06-12-1997

1

2

Jln. Sianipar

0 0

22313 121201 Balige

P. Onan

0206030101 Puskesmas 0 Balige

132 12120102021100101212016808500001Togi br. Tamba

I

Tamba

23-08-1950

2

2

Lbn. Ginabean

0 0

22313 121201 Balige

P. Onan

0206030101 Puskesmas 0 Balige

133 3901036KK2006

I

Balige

28-10-1937

2

1

Lbn. Sianipar

0 0

22313 121201 Balige

P. Onan

0206030101 Puskesmas 0 Balige

134 12120114111100031212014107080001Gracie Pardede

A

Balige

07-01-2008

2

2

P. Onan

0 0

22313 121201 Balige

P. Onan

0206030101 Puskesmas 0 Balige

135 121201210610000412120131240002

P

Sigumpar Julu

31-12-1940

1

1

P.Onan

0 0

22313 121201 Balige

P.Onan

0206030101 Puskesmas 0 Balige

136 12120113101000061212012804810002Ingot Sitohang

P

Sumbul Tengah 28-04-1981

1

1

P.Onan

0 0

22313 121201 Balige

P.Onan

0206030101 Puskesmas 0 Balige

137 12120114111100031212010159088200Mariani Aritonang

I

Belawan

19-08-1982

2

1

P.Onan

0 0

22313 121201 Balige

P.Onan

0206030101 Puskesmas 0 Balige

138 12120102121000071212011801850004Jeprin Gultom

A

Balige

18-01-1985

1

2

P.Onan

0 0

22313 121201 Balige

P.Onan

0206030101 Puskesmas 0 Balige

139 12120113101000061212010303110001Daniel Sitohang

A

Balige

03-03-2011

1

2

P.Onan

0 0

22313 121201 Balige

P.Onan

0206030101 Puskesmas 0 Balige

140 12120116041200011212015404940001Mariani Pardede

A

Balige

14-04-1994

2

2

P.Onan

0 0

22313 121201 Balige

P.Onan

0206030101 Puskesmas 0 Balige

141 12120116041200011212015810010001Arta Pardede

A

Balige

18-10-2001

2

2

P.Onan

0 0

22313 121201 Balige

P.Onan

0206030101 Puskesmas 0 Balige

142 12120120041000141212014203510002Repina Siahaan

I

P. Bandar

02-03-1951

2

1

Nagatimbul

0 0

22313 121201 Balige

P. Onan

0206030101 Puskesmas 0 Balige

1212016810370002Herlina Aritonang

T. Saulus Simanjuntak

143 121204304710013 1212115707744001Siaida Silaen

I

Lumban Gaol

17-09-1974

2

2

R.T Buhit

0 0

22313 121201 Balige

P. Onan

0206030101 Puskesmas 0 Balige

144 12120111066200011212015012530003Magdalena Sianipar

I

Kisaran

10-121953

2

2

Siliwangi

0 0

22313 121201 Balige

P. Onan

0206030101 Puskesmas 0 Balige

145 12120119081000071212015210620003Anita Pardede

P

Balige

12-10-1962

2

3

P. Onan

0 0

22313 121201 Balige

P.Onan

0206030101 Puskesmas 0 Balige

146 12120108020802851212015911690001Sonty Nasrina Pasaribu

I

Medan

19-11-1969

2

1

Sosor Gurgur

0 0

22313 121201 Balige

P. Onan

0206030101 Puskesmas 0 Balige

147 12120108020802851212015911010001Elsa Nova Sitinjak

A

Medan

19-11-2001

2

2

Sosor Gurgur

0 0

22313 121201 Balige

P. Onan

0206030101 Puskesmas 0 Balige

0 0

22313 121201 Balige

P. Onan

0206030101 Puskesmas 0 Balige

148

Lambok Barimbing

149 12120122120900021212011503720003Prancis Siahaan

P

Sidamanik

15-03-1972

1

1

Lbn. Bulbul

0 0

22313 121201 Balige

Lbn. Bulbul

0206030101 Puskesmas 0 Balige

150 12120122129900021212014506720000Juni Rina Pardede

I

Parsikkaman

05-06-1972

2

1

Lbn. Bulbul

0 0

22313 121201 Balige

Lbn. Bulbul

0206030101 Puskesmas 0 Balige

151 12120117120800051212011206030004Vander Siahaan

A

Lbn. Bulbul

11-06-2003

1

2

Lbn. Bulbul

0 0

22313 121201 Balige

Lbn. Bulbul

0206030101 Puskesmas 0 Balige

152 12120122120900021212012512060003Natal Siahaan

A

Lbn. Bulbul

25-12-2006

1

2

Lbn. Bulbul

0 0

22313 121201 Balige

Lbn. Bulbul

0206030101 Puskesmas 0 Balige

153 12120125120600031212091901660001Hotman Simangunsong

S

Balige

19-01-1966

1

1

Lbn. Bulbul

0 0

22313 121201 Balige

Lbn. Bulbul

0206030101 Puskesmas 0 Balige

154 12710927120600031212094506780001Rut Yana Hutagaol

I

Bekasi

05-06-1978

2

1

Lbn. Bulbul

0 0

22313 121201 Balige

Lbn. Bulbul

0206030101 Puskesmas 0 Balige

155 12120113021400021212010406520001Oloan rumintang

P

Lbn. Gorat

04-06-1952

1

1

Lbn. Gorat

0 0

22313 121201 Balige

Lbn. Gorat

0206030101 Puskesmas 0 Balige

156 12120114070900101212015908470002Tiurlan Simanjuntak

I

Parsuratan

19-08-1947

2

1

Lbn. Gorat

0 0

22313 121201 Balige

Lbn. Gorat

0206030101 Puskesmas 0 Balige

157 12120113061100031212012706740003Lamhot Siahaan

P

Lbn. Gorat

27-06-1974

1

1

Lbn. Gorat

0 0

22313 121201 Balige

Lbn. Gorat

0206030101 Puskesmas 0 Balige

158 12120113061100031212014303490002Senti Aritonang

I

P. Siantar

07-03-1996

2

1

Lbn. Gorat

0 0

22313 121201 Balige

Lbn. Gorat

0206030101 Puskesmas 0 Balige

159 1212013101080023121201410160003 Yannur Siahaan

I

Lbn. Gorat

01-01-1960

2

1

Lbn. Gorat

0 0

22313 121201 Balige

Lbn. Gorat

0206030101 Puskesmas 0 Balige

160 1212011302080326121201611070003 Melati Marpaung

A

Balige

27-11-2007

2

2

Matio

0 0

22313 121201 Balige

Matio

0206030101 Puskesmas 0 Balige

161 121201054080002 1212010166105700Rusmi Siagian

I

Sihobuk

26-10-1957

2

1

Matio

0 0

22313 121201 Balige

Matio

0206030101 Puskesmas 0 Balige

162 12120109010900081212015801840000Andina Panjaitan

I

Matio

18-01-1994

2

1

Matio

0 0

22313 121201 Balige

Matio

0206030101 Puskesmas 0 Balige

163 1212012609130003121201150249002 Jausmin Panjaitan

P

Matio

27-02-1949

1

1

Matio

0 0

22313 121201 Balige

Matio

0206030101 Puskesmas 0 Balige

164 12120117125500241212015508560001Rita Tambunan

I

Baruara

15-08-1956

2

1

Matio

0 0

22313 121201 Balige

Matio

0206030101 Puskesmas 0 Balige

165 1212011511110004121201230875002 Hendri P. Hutagaol

P

Balige

23-08-1975

1

1

Mejan

0 0

22313 121201 Balige

Hutabulu Mejan

0206030101 Puskesmas 0 Balige

166 12120115028000151212015008520002Roida Hutagaol

I

Hutagaol

10-08-1952

2

1

Mejan

0 0

22313 121201 Balige

Hutabulu Mejan

0206030101 Puskesmas 0 Balige

167 12120115063700151212011506370015Dompak Tambunan

P

Mejan

15-06-1937

1

1

Mejan

0 0

22313 121201 Balige

Hutabulu Mejan

0206030101 Puskesmas 0 Balige

168 12120120020801981212010406070001Bastanta Siagian

A

Mejan

04-06-2007

?

2

Mejan

0 0

22313 121201 Balige

Hutabulu Mejan

0206030101 Puskesmas 0 Balige

169 12120120046200201212012004620020Bona Parte Hutagaol

P

Mejan

20-04-1962

1

1

Mejan

0 0

22313 121201 Balige

Hutabulu Mejan

0206030101 Puskesmas 0 Balige

170 12120120020801141212012002080114Norma Sinambela

I

Narumonda

11-03-1942

2

1

Mejan

0 0

22313 121201 Balige

Hutabulu Mejan

0206030101 Puskesmas 0 Balige

171 12120130091000021212015408580002Rukini Tampubolon

P

Pardagangan

14-08-1958

2

3

Paindoan

0 0

22313 121201 Balige

Paindoan

0206030101 Puskesmas 0 Balige

172 12120108095000081212016802320002Tamaria Hutahean

I

Pardagangan

28-02-1938

2

1

Paindoan

0 0

22313 121201 Balige

Paindoan

0206030101 Puskesmas 0 Balige

173 12120128061000101212010608500001Sunggul Siahaan

P

Paindoan

08-06-1950

1

1

Paindoan

0 0

22313 121201 Balige

Paindoan

0206030101 Puskesmas 0 Balige

174 121201120800005 1212016410660001Suryani Guci

I

Balige

24-10-1966

2

1

Paindoan

0 0

22313 121201 Balige

Paindoan

0206030101 Puskesmas 0 Balige

175 12120125081000031212015010550001Erminia Napitupulu

I

Doloksanggul

10-10-1955

2

1

Paindoan

0 0

22313 121201 Balige

Paindoan

0206030101 Puskesmas 0 Balige

176 12120113070900041212010412550003Volmer Siahaan

P

Paindoan

04-12-1955

1

1

Paindoan

0 0

22313 121201 Balige

Paindoan

0206030101 Puskesmas 0 Balige

177 12120128070900131212010505600001Jaiman Tampubolon

P

Pandumayu

05-05-1960

1

1

Paindoan

0 0

22313 121201 Balige

Paindoan

0206030101 Puskesmas 0 Balige

178 12120128070900131212015506620001Pariama Simanjuntak

I

Onan Sampang 15-06-1962

2

1

Paindoan

0 0

22313 121201 Balige

Paindoan

0206030101 Puskesmas 0 Balige

179 12120115060900011212015202590001Rolli Pasaribu

I

Parsoburan

12-02-1959

2

1

Paindoan

0 0

22313 121201 Balige

Paindoan

0206030101 Puskesmas 0 Balige

180 12120127010900051212012208110013Semma Wati

I

Balige

25-11-1964

2

1

Parsuratan

0 0

22313 121201 Balige

Parsuratan

0206030101 Puskesmas 0 Balige

181 12120122008110011212013101990001Marihot Simanjuntak

A

Parsuratan

31-01-1999

1

2

Parsuratan

0 0

22313 121201 Balige

Parsuratan

0206030101 Puskesmas 0 Balige

182 12120128070900181212011607630000Togar Simanjuntak

I

Negeri Lama

16-07-1963

2

1

Parsuratan

0 0

22313 121201 Balige

Parsuratan

0206030101 Puskesmas 0 Balige

183 12120128070900281212016907030001Julik Simanjuntak

A

Hutagaol

31-01-2000

2

2

Parsuratan

0 0

22313 121201 Balige

Parsuratan

0206030101 Puskesmas 0 Balige

184 12120128070900181212011606110011Porman Simanjuntak

I

Laguboti

11-03-1979

2

1

Parsuratan

0 0

22313 121201 Balige

Parsuratan

0206030101 Puskesmas 0 Balige

185 121204602110011 1212011304710013Tiolida Sihombing

I

Kota cane

26-08-1974

2

1

Parsuratan

0 0

22313 121201 Balige

Parsuratan

0206030101 Puskesmas 0 Balige

186 12120104031100081212015712430003Rena Sinaga

P

Bah Jambi

17-12-1943

2

3

Parsuratan

0 0

22313 121201 Balige

Parsuratan

0206030101 Puskesmas 0 Balige

187 12120106120700541212013112470002Joyakin Simanjuntak

P

Parsuratan

31-12-1947

1

4

Parsuratan

0 0

22313 121201 Balige

Parsuratan

0206030101 Puskesmas 0 Balige

188 12120102111000021212014607820002Dorta Sihite

I

Hutaginjang

06-07-1982

2

1

Parsuratan

0 0

22313 121201 Balige

Parsuratan

0206030101 Puskesmas 0 Balige

189 12120129111300021212013009510003Harungguan Siahaan

P

Balige

30-09-1951

1

1

Sibolahotang SAS

0 0

22313 121201 Balige

Sibolahotang SAS 0206030101 Puskesmas 0 Balige

190 12120122120900161212010511690001Pahotan Tanpubolon

P

Balige

05-11-1969

1

1

Sibolahotang SAS

0 0

22313 121201 Balige

Sibolahotang SAS 0206030101 Puskesmas 0 Balige

191 12120111212070061212012501750003Tangkas P. Tampubolon

P

Sibulele

25-01-1975

1

1

Sibolahotang SAS

0 0

22313 121201 Balige

Sibolahotang SAS 0206030101 Puskesmas 0 Balige

192 12120111109120001212012211660002Joni Aritonang

P

Aritonang

22-12-1966

1

1

Sibolahotang SAS

0 0

22313 121201 Balige

Sibolahotang SAS 0206030101 Puskesmas 0 Balige

0 0

22313 121201 Balige

Sibolahotang SAS 0206030101 Puskesmas 0 Balige

193

Timbul E Larosa

194 12120117101100161212015504930003Nurcahaya Butar-Butar

I

Tampubolon

15-04-1993

2

1

Sibolahotang SAS

0 0

22313 121201 Balige

Sibolahotang SAS 0206030101 Puskesmas 0 Balige

195 1212010705090002121201120242001 Kasima Siahaan

P

Siboruon

12-02-1942

1

1

Siboruan

0 0

22313 121201 Balige

Siboruan

0206030101 Puskesmas 0 Balige

196

1212012509470025Tohap Simanjuntak

P

Sihatandokan

25-09-1947

1

4

Siboruon

0 0

22313 121201 Balige

Siboruan

0206030101 Puskesmas 0 Balige

197 263110145/TU79 1212015111540051Eleria Simanjuntak

I

Parapat

23-06-1950

2

1

Siboruon

0 0

22313 121201 Balige

Siboruan

0206030101 Puskesmas 0 Balige

198 12120113105100131212014701850006Trina Siahaan

I

Siboruon

07-01-1985

2

1

Siboruon

0 0

22313 121201 Balige

Siboruan

0206030101 Puskesmas 0 Balige

199 12120127031300011212015205310001Rimmy T Hutagalung

I

Sibaruan

12-05-2013

2

1

Siboruan

0 0

22313 121201 Balige

Siboruan

0206030101 Puskesmas 0 Balige

200 12120127031300011212010703820003Risman Hutagalung

A

Sibuntuon

07-03-1982

1

2

Siboruan

0 0

22313 121201 Balige

Siboruan

0206030101 Puskesmas 0 Balige

201 12120119101200011271183006820009Batara Sianturi

P

Simatupang

30-06-1982

1

1

Siboruon

0 0

22313 121201 Balige

Siboruon

0206030101 Puskesmas 0 Balige

202 12120119101200011212010306100004Marcel Sianturi

A

Medan

06-03-2010

1

2

Siboruon

0 0

22313 121201 Balige

Siboruon

0206030101 Puskesmas 0 Balige

-

203 12120119101200011212012805130001Rafael Sianturi

A

Balige

28-05-2013

1

2

Siboruon

0 0

22313 121201 Balige

Siboruon

0206030101 Puskesmas 0 Balige

204 12120127030001 1212011912730002Larly Damanik

I

Siantar

27-02-1983

2

1

Sibuntuon

0 0

22313 121201 Balige

Sibuntuon

0206030101 Puskesmas 0 Balige

205 12120110065300011212015507420002Tiurlan Silaban

I

Siborong borong

06-10-1942

2

1

Sibuntuon

0 0

22313 121201 Balige

pp

0206030101 Puskesmas 0 Balige

206 12120155074200021212011006530003Julifer Siahaan

I

Sibuntuon

22-04-1942

2

1

Sibuntuon

0 0

22313 121201 Balige

Sibuntuon

0206030101 Puskesmas 0 Balige

207 12120110065300031212016408400002Timoria Sirait

I

Tp. Bolon

24-08-1940

2

1

Sibuntuon

0 0

22313 121201 Balige

Sibuntuon

0206030101 Puskesmas 0 Balige

208 12120164084000021212011106620001Gunawan Siahaan

P

Sibuntuon

11-06-1962

1

1

Sibuntuon

0 0

22313 121201 Balige

Sibuntuon

0206030101 Puskesmas 0 Balige

209 12120428011400041202040404860004Marlan Siregar

P

Hutaraja

04-04-1986

1

1

Tambunan Sunge

0 0

22313 121201 Balige

Tambunan Sunge 0206030101 Puskesmas 0 Balige

210 12120113020800121212014906690001Delima Parhusip

I

Samosir

09-06-1959

2

1

Tambunan Sunge

0 0

22313 121201 Balige

Tambunan Sunge 0206030101 Puskesmas 0 Balige

211 12120112111300021202014802900001Eni Nurcahaya Tobing

A

Tarutung

08-02-1990

2

2

Sianipar

0 0

22313 121201 Balige

Balige II

0206030101 Puskesmas 0 Balige

212 12020118070812191212011307060003Rehan Sianipar

A

Bange

13-07-2006

1

2

Sianipar Tangga

0 0

22313 121201 Balige

Balige II

0206030101 Puskesmas 0 Balige

213 12120127121100031212010910130001Parningotan Sinaga

A

Balige

27-12-2011

1

2

Sosor Tangga

0 0

22313 121201 Balige

Balige II

0206030101 Puskesmas 0 Balige

214 12120125051100011212011101480001Rumina Napitupulu

I

Siborong borong

11-11-1948

2

1

Umarihit

0 0

22313 121201 Balige

Balige II

0206030101 Puskesmas 0 Balige

215 121201060309005 1212010810550001Belman Sinaga

P

Balige

08-10-1955

1

4

Balige II

0 0

22313 121201 Balige

Balige II

0206030101 Puskesmas 0 Balige

216 12120107041100041212012708820002Royen Caprin Sianipar

P

Balige

27-08-1982

1

1

Balige II

0 0

22313 121201 Balige

Balige II

0206030101 Puskesmas 0 Balige

217 12120107041100041212015807770002Sewantika Simanjuntak

I

Balige

18-07-1977

2

1

Balige II

0 0

22313 121201 Balige

Balige II

0206030101 Puskesmas 0 Balige

218 12120115101200271212012711700003Pamindo Tambunan

P

Balige

27-11-1970

1

1

Balige II

0 0

22313 121201 Balige

Balige II

0206030101 Puskesmas 0 Balige

219 12120115101200271212016609130001Tio Cristabel Tambunan

A

Balige II

26-09-2013

2

2

Balige II

0 0

22313 121201 Balige

Balige II

0206030101 Puskesmas 0 Balige

220 12120122031000031212014709610001Sumiati

P

Tulang Agung

07-09-1961

2

3

L. Dolok H.Bange

0 0

22313 121201 Balige

L. Dolok H.Bange 0206030101 Puskesmas 0 Balige

221 12120121070900071212012109520005Tamba Pardede

P

Balige

21-09-1952

1

1

L. Dolok H.Bange

0 0

22313 121201 Balige

L. Dolok H.Bange 0206030101 Puskesmas 0 Balige

222 12120117121000081212015809870001Ipah Seperina

I

Jakarta

18-05-1975

2

1

L. Dolok H.Bange

0 0

22313 121201 Balige

L. Dolok H.Bange 0206030101 Puskesmas 0 Balige

223 12120117021100091212015406890002Junita Siagian

I

Medan

14-06-1989

2

1

L. Dolok H.Bange

0 0

22313 121201 Balige

L. Dolok H.Bange 0206030101 Puskesmas 0 Balige

224 12120117021100091212016604090001Naomi Pardede

A

Tangerang

26-04-2009

2

2

L. Dolok H.Bange

0 0

22313 121201 Balige

L. Dolok H.Bange 0206030101 Puskesmas 0 Balige

225 12120110081100091212016103750001Sri Ajeng Rukmawati

I

Jakarta

21-03-1975

2

1

L. Dolok H.Bange

0 0

22313 121201 Balige

L. Dolok H.Bange 0206030101 Puskesmas 0 Balige

226 12120107091000091212011610950002Juanda Pardede

A

Medan

10-10-1995

1

2

L. Dolok H.Bange

0 0

22313 121201 Balige

L. Dolok H.Bange 0206030101 Puskesmas 0 Balige

227 12120110081100091212011905650019Johansen Pardede

P

Balige

16-05-1965

1

1

L. Dolok H.Bange

0 0

22313 121201 Balige

L. Dolok H.Bange 0206030101 Puskesmas 0 Balige

228 12120119056500191212010704870001Adi Syah Putra

A

Balige

07-04-1967

1

2

L. Dolok H.Bange

0 0

22313 121201 Balige

L. Dolok H.Bange 0206030101 Puskesmas 0 Balige

229 12120119050900411212011709560001Biyadi

P

P. Siantar

17-09-1956

1

1

L. Dolok H.Bange

0 0

22313 121201 Balige

L. Dolok H.Bange 0206030101 Puskesmas 0 Balige

230 12120121121000011212015608690004Rita Tambunan

I

T. Jawa

16-08-1969

2

1

L. Dolok H.Bange

0 0

22313 121201 Balige

L. Dolok H.Bange 0206030101 Puskesmas 0 Balige

231

Herikson Napitupulu

0 0

22313 121201 Balige

L. Dolok H.Bange 0206030101 Puskesmas 0 Balige

232

Christian

0 0

22313 121201 Balige

L. Dolok H.Bange 0206030101 Puskesmas 0 Balige

233 12120129111100071212015405890004Isabella Malau

A

Medan

14-05-1989

2

2

L. Dolok H.Bange

0 0

22313 121201 Balige

L. Dolok H.Bange 0206030101 Puskesmas 0 Balige

234 12120117031000081212014606470002Tianna Hutahaean

P

Laguboti

06-06-1947

2

3

L. Dolok H.Bange

0 0

22313 121201 Balige

L. Dolok H.Bange 0206030101 Puskesmas 0 Balige

235 12120116121000021212011808100002Thobias H Pardede

A

Balige

18-08-2010

1

2

L. Dolok H.Bange

0 0

22313 121201 Balige

L. Dolok H.Bange 0206030101 Puskesmas 0 Balige

236 12120116121000021212017011830001Rita Dewi Sitanggang

I

Siantar

30-11-1983

2

1

L. Dolok H.Bange

0 0

22313 121201 Balige

L. Dolok H.Bange 0206030101 Puskesmas 0 Balige

237 121201911110002 1212010510790004Maneak Tua T Siahaan

P

Balige

05-10-1979

1

1

Lbn. Silintong

0 0

22313 121201 Balige

Lbn. Silintong

0206030101 Puskesmas 0 Balige

238 121201911110002 1212014411570001Saurlina Siallagan

I

Kamp. Jagung

04-11-1957

2

1

Lbn. Silintong

0 0

22313 121201 Balige

Lbn. Silintong

0206030101 Puskesmas 0 Balige

239 12120126091100111212012803700003Bulungan Pandiangan

P

Lbn. Bulbul

28-03-1970

1

1

Lbn. Bulbul

0 0

22313 121201 Balige

Lbn. Bulbul

0206030101 Puskesmas 0 Balige

240 12120126091100111212016601690001Tiurlan Hutajulu

I

Lbn. Bulbul

26-01-1969

2

1

Lbn. Bulbul

0 0

22313 121201 Balige

Lbn. Bulbul

0206030101 Puskesmas 0 Balige

241 12120126091100111212010804000004Dimas Doni Pandiangan

A

Lbn. Bulbul

08-04-2000

1

2

Lbn. Bulbul

0 0

22313 121201 Balige

Lbn. Bulbul

0206030101 Puskesmas 0 Balige

242 12120126091100111212014301070006Ratu Celsia Pandiangan

A

Lbn. Bulbul

03-01-2007

2

2

Lbn. Bulbul

0 0

22313 121201 Balige

Lbn. Bulbul

0206030101 Puskesmas 0 Balige

243 12120113101000011212011608520003Sahat Panjaitan

P

Matio

16-08-1952

1

1

Matio

0 0

22313 121201 Balige

Matio

0206030101 Puskesmas 0 Balige

244 12120119111100041212010703720004Riduan Panjaitan

P

Matio

03-07-1972

1

1

Matio

0 0

22313 121201 Balige

Matio

0206030101 Puskesmas 0 Balige

245 12120119111100041212014611830003Ellen Ridawati Doloksaribu

I

Sibuntuon

11-06-1983

2

1

Matio

0 0

22313 121201 Balige

Matio

0206030101 Puskesmas 0 Balige

246 12120109051200031272011208680002Parluhutan Simanjuntak

P

Hutadame

08-12-1968

1

1

Hutadame

0 0

22313 121201 Balige

Hutadame

Puskesmas 0206030101 Balige 0

247 12120109051200031272015201810004Riris Maita Elidaniar Sianturi

I

Kisaran

01-12-1981

2

1

Hutadame

0 0

22313 121201 Balige

Hutadame

0206030101 Puskesmas 0 Balige

248 12120109051200031272012712100001Dion Wahyu Simanjuntak

A

P. Siantar

27-12-2010

1

2

Hutadame

0 0

22313 121201 Balige

Hutadame

0206030101 Puskesmas 0 Balige

249 12120119101000051212010112630002Ronald Siahaan

P

Paindoan

12-01-1963

1

1

Paindoan

0 0

22313 121201 Balige

Paindoan

0206030101 Puskesmas 0 Balige

250 12120119101000051212014211680002Rosinta Simanjuntak

I

Peatalun

11-02-1968

2

1

Paindoan

0 0

22313 121201 Balige

Paindoan

0206030101 Puskesmas 0 Balige

Dumaria Siahaan Dapot Sianipar Morita Hutagaol Mangantar Tambunan Marince Tampubolon Merdeka Tambunan

Lampiran Keputusan Bupati/Walikota Nomor : Tanggal:

No. NPWP No Passport

Keterangan

28 29 30 31 32 33 34

35

Nama Asuransi

1=Kelas 1=Tetap, I, 2=Kontra 2=Kelas k, II, 3=Paruh 3=Kelas waktu III

Asuran si Lainny a

No. Polis

22232425

Kelas Rawat

Gapok / Pensiunan 1=WNI, Kewarga 2=WNA Negaraan

Nomor Telepon Email NPP Jabatan

21

Status

TMT Kerja

Nama Faskes Dokter Gigi

R

26

27

Poli Gigi 0 0 0 0

1

3

0

0

1

0

0

0 0

Poli Gigi 0 0 0 0

1

3

0

0

1

0

0

0 0

Poli Gigi 0 0 0 0

1

3

0

0

1

0

0

0 0

Poli Gigi 0 0 0 0

1

3

0

0

1

0

0

0 0

Poli Gigi 0 0 0 0

1

3

0

0

1

0

0

0 0

Poli Gigi 0 0 0 0

1

3

0

0

1

0

0

0 0

Poli Gigi 0 0 0 0

1

3

0

0

1

0

0

0 0

Poli Gigi 0 0 0 0

1

3

0

0

1

0

0

0 0

Poli Gigi 0 0 0 0

1

3

0

0

1

0

0

0 0

Poli Gigi 0 0 0 0

1

3

0

0

1

0

0

0 0

Poli Gigi 0 0 0 0

1

3

0

0

1

0

0

0 0

Poli Gigi 0 0 0 0

1

3

0

0

1

0

0

0 0

Poli Gigi 0 0 0 0

1

3

0

0

1

0

0

0 0

Poli Gigi 0 0 0 0

1

3

0

0

1

0

0

0 0

Poli Gigi 0 0 0 0

1

3

0

0

1

0

0

Blm 0 0 punya kartu

Poli Gigi 0 0 0 0

1

3

0

0

1

0

0

0 0

Poli Gigi 0 0 0 0

1

3

0

0

1

0

0

0 0

Poli Gigi 0 0 0 0

1

3

0

0

1

0

0

0 0

Poli Gigi 0 0 0 0

1

3

0

0

1

0

0

0 0

Poli Gigi 0 0 0 0

1

3

0

0

1

0

0

0 0

Poli Gigi 0 0 0 0

1

3

0

0

1

0

0

0 0

Poli Gigi 0 0 0 0

1

3

0

0

1

0

0

0 0

Poli Gigi 0 0 0 0

1

3

0

0

1

0

0

0 0

Poli Gigi 0 0 0 0

1

3

0

0

1

0

0

0 0

Poli Gigi 0 0 0 0

1

3

0

0

1

0

0

0 0

Poli Gigi 0 0 0 0

1

3

0

0

1

0

0

0 0

Poli Gigi 0 0 0 0

1

3

0

0

1

0

0

0 0

Poli Gigi 0 0 0 0

1

3

0

0

1

0

0

0 0

Poli Gigi 0 0 0 0

1

3

0

0

1

0

0

blm 0 0 punya kartu

Poli Gigi 0 0 0 0

1

3

0

0

1

0

0

blm 0 0 punya kartu

Poli Gigi 0 0 0 0

1

3

0

0

1

0

0

blm 0 0 punya kartu

Poli Gigi 0 0 0 0

1

3

0

0

1

0

0

0 0

Poli Gigi 0 0 0 0

1

3

0

0

1

0

0

0 0

Poli Gigi 0 0 0 0

1

3

0

0

1

0

0

0 0

Poli Gigi 0 0 0 0

1

3

0

0

1

0

0

0 0

Poli Gigi 0 0 0 0

1

3

0

0

1

0

0

0 0

Poli Gigi 0 0 0 0

1

3

0

0

1

0

0

0 0

Poli Gigi 0 0 0 0

1

3

0

0

1

0

0

0 0

Poli Gigi 0 0 0 0

1

3

0

0

1

0

0

0 0

Poli Gigi 0 0 0 0

1

3

0

0

1

0

0

Blm 0 0 punya kartu

Poli Gigi 0 0 0 0

1

3

0

0

1

0

0

Poli Gigi 0 0 0 0

1

3

0

0

1

0

0

Poli Gigi 0 0 0 0

1

3

0

0

1

0

0

0 0

Poli Gigi 0 0 0 0

1

3

0

0

1

0

0

0 0

Poli Gigi 0 0 0 0

1

3

0

0

1

0

0

Blm 0 0 punya kartu

Poli Gigi 0 0 0 0

1

3

0

0

1

0

0

Blm 0 0 punya kartu

Poli Gigi 0 0 0 0

1

3

0

0

1

0

0

Blm 0 0 punya kartu

Poli Gigi 0 0 0 0

1

3

0

0

1

0

0

Blm 0 0 punya kartu

Poli Gigi 0 0 0 0

1

3

0

0

1

0

0

Blm 0 0 punya kartu

Poli Gigi 0 0 0 0

1

3

0

0

1

0

0

Blm 0 0 punya kartu

Poli Gigi 0 0 0 0

1

3

0

0

1

0

0

0 0

Poli Gigi 0 0 0 0

1

3

0

0

1

0

0

0 0

Blm 0 0 punya kartu Blm 0 0 punya kartu

Poli Gigi 0 0 0 0

1

3

0

0

1

0

0

0 0

Poli Gigi 0 0 0 0

1

3

0

0

1

0

0

0 0

Poli Gigi 0 0 0 0

1

3

0

0

1

0

0

0 0

Poli Gigi 0 0 0 0

1

3

0

0

1

0

0

0 0

Poli Gigi 0 0 0 0

1

3

0

0

1

0

0

0 0

Poli Gigi 0 0 0 0

1

3

0

0

1

0

0

0 0

Poli Gigi 0 0 0 0

1

3

0

0

1

0

0

0 0

Poli Gigi 0 0 0 0

1

3

0

0

1

0

0

0 0

Poli Gigi 0 0 0 0

1

3

0

0

1

0

0

0 0

Poli Gigi 0 0 0 0

1

3

0

0

1

0

0

Blm 0 0 punya kartu

Poli Gigi 0 0 0 0

1

3

0

0

1

0

0

Blm 0 0 punya kartu

Poli Gigi 0 0 0 0

1

3

0

0

1

0

0

0 0

Poli Gigi 0 0 0 0

1

3

0

0

1

0

0

0 0

Poli Gigi 0 0 0 0

1

3

0

0

1

0

0

0 0

Poli Gigi 0 0 0 0

1

3

0

0

1

0

0

0 0

Poli Gigi 0 0 0 0

1

3

0

0

1

0

0

0 0

Poli Gigi 0 0 0 0

1

3

0

0

1

0

0

0 0

Poli Gigi 0 0 0 0

1

3

0

0

1

0

0

0 0

Poli Gigi 0 0 0 0

1

3

0

0

1

0

0

0 0

Poli Gigi 0 0 0 0

1

3

0

0

1

0

0

0 0

Poli Gigi 0 0 0 0

1

3

0

0

1

0

0

0 0

Poli Gigi 0 0 0 0

1

3

0

0

1

0

0

0 0

Poli Gigi 0 0 0 0

1

3

0

0

1

0

0

0 0

Poli Gigi 0 0 0 0

1

3

0

0

1

0

0

0 0

Poli Gigi 0 0 0 0

1

3

0

0

1

0

0

0 0

Poli Gigi 0 0 0 0

1

3

0

0

1

0

0

0 0

Poli Gigi 0 0 0 0

1

3

0

0

1

0

0

0 0

Poli Gigi 0 0 0 0

1

3

0

0

1

0

0

0 0

Poli Gigi 0 0 0 0

1

3

0

0

1

0

0

0 0

Poli Gigi 0 0 0 0

1

3

0

0

1

0

0

0 0

Poli Gigi 0 0 0 0

1

3

0

0

1

0

0

0 0

Poli Gigi 0 0 0 0

1

3

0

0

1

0

0

0 0

Poli Gigi 0 0 0 0

1

3

0

0

1

0

0

0 0

Poli Gigi 0 0 0 0

1

3

0

0

1

0

0

0 0

Poli Gigi 0 0 0 0

1

3

0

0

1

0

0

0 0

Poli Gigi 0 0 0 0

1

3

0

0

1

0

0

Blm 0 0 punya kartu

Poli Gigi 0 0 0 0

1

3

0

0

1

0

0

Blm 0 0 punya kartu

Poli Gigi 0 0 0 0

1

3

0

0

1

0

0

0 0

Poli Gigi 0 0 0 0

1

3

0

0

1

0

0

0 0

Poli Gigi 0 0 0 0

1

3

0

0

1

0

0

0 0

Poli Gigi 0 0 0 0

1

3

0

0

1

0

0

0 0

Poli Gigi 0 0 0 0

1

3

0

0

1

0

0

0 0

Poli Gigi 0 0 0 0

1

3

0

0

1

0

0

0 0

Poli Gigi 0 0 0 0

1

3

0

0

1

0

0

0 0

Poli Gigi 0 0 0 0

1

3

0

0

1

0

0

0 0

Poli Gigi 0 0 0 0

1

3

0

0

1

0

0

0 0

Poli Gigi 0 0 0 0

1

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0

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